Decreased serum thrombospondin-1 levels in pancreatic ductal adenocarcinoma patients: an early indicator of disease or diabetes mellitus development?

Introduction: The prevalence of periodontal disease (POD) among adults aged 30 years and older in the United States is reported to be more than 47%, with higher prevalence seen among patients with diabetes mellitus (DM). POD has been associated with systemic inflammation, a known risk factor for cardiovascular and bone disease, both of which are more common in patients with DM. However, there is mixed evidence that treatment of POD reduces inflammation, improves DM control, and reduces DM complications. Our study objectives are to assess factors associated with POD in patients with DM and determine the impact of POD treatment on inflammation and bone turnover biomarkers associated with complications of DM.Methods: In this pilot study, we will first recruit 200 patients with DM to complete a 48-item investigator-administered questionnaire designed to assess socio-economic status, oral health status, adequacy of oral care, glycemic control and presence of DM complications. Responses will be verified by individual chart review. Then, using a crossover design, a subgroup of 24 subjects with responses suggestive of POD will be assigned to undergo POD treatment for three months followed by three months of routine dental care (group 1) or be followed for three months during routine dental care then receive POD treatment for three months (group 2). Outcome measures will be collected before and after POD treatment and include glycemic control and inflammatory and bone turnover biomarkers.Results: We hypothesize that the prevalence of POD among DM patients will be associated with inadequate glycemic control and greater DM complications.